hypericum and Premenstrual-Syndrome

Complementary and alternative medicine (CAM) approaches are widely used by women with premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). This article provides a comprehensive review of the medical literature on clinical applications of CAM for these conditions. The information was collected via a Medline review dating back to 1966 and subsequent selected review of bibliographies from these articles for non-Medline referenced but relevant clinical studies. For many of the therapies discussed, there is a lack of conclusive evidence either confirming or refuting efficacy. For other therapies, including certain herbal and nutritional approaches, the use of exercise, and the use of mind-body approaches, there is substantial evidence of efficacy. This review will be relevant to the practicing clinician seeking to become aware of and to understand the relevance of the complementary/alternative therapies being used by his/her patients for PMS and PMDD.

Topics: Cimicifuga; Complementary Therapies; Dietary Supplements; Female; Ginkgo biloba; Humans; Hypericum; Kava; Oenothera biennis; Phytotherapy; Premenstrual Syndrome; Randomized Controlled Trials as Topic; Vitex

Topics: Adult; Anthracenes; Double-Blind Method; Female; Humans; Hypericum; Perylene; Phytotherapy; Premenstrual Syndrome; Prospective Studies; Severity of Illness Index; Treatment Outcome; Young Adult

Premenstrual syndrome (PMS) is a common condition. Some of the most widely prescribed medications are selective serotonin reuptake inhibitors (SSRIs), based on the hypothesized role of serotonin in the production of PMS symptoms. PMS sufferers, especially those experiencing mild to moderate symptoms, are often reluctant to take this form of medication and instead buy over-the-counter preparations to treat their symptoms, for which the evidence base with regard to efficacy is limited. Hypericum perforatum (St John's wort) influences the serotonergic system. As such, this widely available herbal remedy deserves attention as a PMS treatment.. To investigate the effectiveness of Hypericum perforatum on symptoms of PMS.. This randomized, double-blind, placebo-controlled, crossover study was conducted between November 2005 and June 2007.. Institute of Psychological Sciences, University of Leeds, Leeds, UK.. 36 women aged 18-45 years with regular menstrual cycles (25-35 days), who were prospectively diagnosed with mild PMS.. Women who remained eligible after three screening cycles (n = 36) underwent a two-cycle placebo run-in phase. They were then randomly assigned to receive Hypericum perforatum tablets 900 mg/day (standardized to 0.18% hypericin; 3.38% hyperforin) or identical placebo tablets for two menstrual cycles. After a placebo-treated washout cycle, the women crossed over to receive placebo or Hypericum perforatum for two additional cycles.. Symptoms were rated daily throughout the trial using the Daily Symptom Report. Secondary outcome measures were the State Anxiety Inventory, Beck Depression Inventory, Aggression Questionnaire and Barratt Impulsiveness Scale. Plasma hormone (follicle-stimulating hormone [FSH], luteinizing hormone [LH], estradiol, progesterone, prolactin and testosterone) and cytokine (interleukin [IL]-1beta, IL-6, IL-8, interferon [IFN]-gamma and tumour necrosis factor [TNF]-alpha) levels were measured in the follicular and luteal phases during Hypericum perforatum and placebo treatment.. Hypericum perforatum was statistically superior to placebo in improving physical and behavioural symptoms of PMS (p < 0.05). There were no significant effects of Hypericum perforatum compared with placebo treatment for mood- and pain-related PMS symptoms (p > 0.05). Plasma hormone (FSH, LH, estradiol, progesterone, prolactin and testosterone) and cytokine (IL-1beta, IL-6, IL-8, IFNgamma and TNFalpha) levels, and weekly reports of anxiety, depression, aggression and impulsivity, also did not differ significantly during the Hypericum perforatum and placebo cycles (p > 0.05).. Daily treatment with Hypericum perforatum was more effective than placebo treatment for the most common physical and behavioural symptoms associated with PMS. As proinflammatory cytokine levels did not differ significantly between Hypericum perforatum and placebo treatment, these beneficial effects are unlikely to be produced through this mechanism of action alone. Further work is needed to determine whether pain- and mood-related PMS symptoms benefit from longer treatment duration. Trial registration number (International Standard Randomised Controlled Trial Number Register) ISRCTN31487459.

Topics: Adolescent; Adult; Cross-Over Studies; Cytokines; Dose-Response Relationship, Drug; Double-Blind Method; Female; Hormones; Humans; Hypericum; Middle Aged; Phytotherapy; Plant Preparations; Premenstrual Syndrome; Statistics, Nonparametric; Treatment Outcome; Young Adult

It has been suggested that some of the symptoms typically attributed to menopause may be more related to premenstrual syndrome (PMS) than menopause, as perimenopausal women appear to be more prone to PMS-like symptoms, or at least to tolerate them less well.. The objective of this study was to evaluate the effectiveness of a phytotherapeutic intervention comprising a combination of Hypericum perforatum (St. John's wort) and Vitex agnus-castus (chaste tree/berry) in the management of PMS-like symptoms in perimenopausal women.. A double-blind, randomized, placebo-controlled parallel trial was conducted over 16 weeks on menopause-related symptoms. Data on PMS-like symptoms were collected at 4-weekly intervals from a small subgroup of late-perimenopausal women (n = 14) participating in this study. The primary endpoint was PMS scores measured on the Abrahams Menstrual Symptoms Questionnaire, comprising the subclusters of PMS-A (anxiety), PMS-D (depression), PMS-H (hydration), and PMS-C (cravings). Herbal combination therapy or placebo tablets were administered twice daily.. At the end of the 16-week treatment phase, analyses of covariance showed the herbal combination to be superior to placebo for total PMS-like scores (p = 0.02), PMS-D (p = 0.006), and PMS-C clusters (p = 0.027). The active treatment group also showed significant reductions in the anxiety (p = 0.003) and hydration (p = 0.002) clusters, using paired-samples t tests. Results of trend analyses showed significant treatment group effects across the five phases for total PMS and all subscales, all in the clinically expected direction. No significant trends were evident in the placebo group.. These results suggest a potentially significant clinical application for this phytotherapeutic combination in PMS-like symptoms among perimenopausal women. Further research is warranted through a randomized, controlled trial dedicated to investigation of these symptoms.

Topics: Analysis of Variance; Anxiety; Appetite; Dehydration; Depression; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Hypericum; Middle Aged; Perimenopause; Phytotherapy; Plant Extracts; Premenstrual Syndrome; Vitex

This study aimed to investigate the efficacy of St. John's wort extract (SJW) as a treatment for premenstrual symptoms.. The study was a randomized, double-blinded, placebo-controlled trial, with two parallel treatment groups. After a no-treatment baseline cycle, volunteers were randomized to either SJW or placebo for a further two menstrual cycles.. A postal trial conducted from The University of Reading, Berkshire, England.. One hundred and sixty-nine (169) normally menstruating women who experienced recurrent premenstrual symptoms were recruited onto the study. One hundred and twenty-five (125) completed the protocol and were included in the analysis.. Six hundred milligrams (600) mg of SJW (standardized to contain 1800 microg of hypericin) or placebo (containing lactose and cellulose).. A menstrual diary was used to assess changes in premenstrual symptoms. The anxiety-related subgroup of symptoms of this instrument was used as the primary outcome measure.. After averaging the effects of treatment over both treatment cycles it was found that there was a trend for SJW to be superior to placebo. However, this finding was not statistically significant.. The possibility that this nonsignificant finding resulted from insufficient statistical power in the study, rather than a lack of efficacy of SJW, is discussed. Following this discussion the recommendation is made that, in future, similar studies should be powered to detect a minimum clinically relevant difference between treatments.

Topics: Adult; Anti-Anxiety Agents; Antidepressive Agents; Anxiety; Depression; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; England; Female; Humans; Hypericum; Phytotherapy; Plant Extracts; Premenstrual Syndrome; Regression Analysis; Treatment Outcome

Topics: Calcium; Crocus; Female; gamma-Linolenic Acid; Humans; Hypericum; Linoleic Acids; Magnesium; Oenothera biennis; Phytotherapy; Plant Oils; Plants, Medicinal; Premenstrual Syndrome; Pyridoxine; Vitex

Topics: Adult; Attention Deficit Disorder with Hyperactivity; Female; Humans; Hypericum; Phytotherapy; Plant Extracts; Premenstrual Syndrome; Treatment Outcome

Premenstrual dysphoric disorder (PMDD), a menstruous dysfunction, is characterized by profoundly depressed mood, and studies have shown that antidepressants are effective for PMDD. The authors describe a case of PMDD who was initially treated with selective serotonin reuptake inhibitors. Due to intolerable gastrointestinal side effects with selective serotonin reuptake inhibitors, St. John's wort (900 mg/day) was substituted and much improvement in PMDD symptoms was noted for at least five-month follow-up. The authors propose that St. John's wort could be an alternative medication for PMDD, especially for patients experiencing intolerable side effects with selective serotonin reuptake inhibitors.

Topics: Adult; Female; Humans; Hypericum; Phytotherapy; Premenstrual Syndrome

To investigate whether Hypericum perforatum could relieve symptoms of premenstrual syndrome in a small group of women in order to establish a hypothesis and to test methods for conducting a future randomised controlled trial.. Prospective, open, uncontrolled, observational study.. Department of Complementary Medicine, University of Exeter.. Nineteen women with premenstrual syndrome who were in otherwise good physical and mental health and not taking other treatments for premenstrual syndrome.. Volunteers underwent a preliminary screening interview, completed Daily Symptom Ratings for one cycle, and attended a medical screening visit before being diagnosed with premenstrual syndrome. Participants took hypericum tablets for two complete menstrual cycles (1 x 300 mg hypericum extract per day standardised to 900 microg hypericin).. Symptoms were rated daily throughout the trial using a validated measure. The Hospital Anxiety and Depression scale and modified Social Adjustment Scale were administered at baseline and after one and two cycles of treatment.. There were significant reductions in all outcome measures. The degree of improvement in overall premenstrual syndrome scores between baseline and the end of the trial was 51%, with over two-thirds of the sample demonstrating at least a 50% decrease in symptom severity. Tolerance and compliance with the treatment were encouraging.. The results of this pilot study suggest that there is scope for conducting a randomised, placebo-controlled, double-blind trial to investigate the value of hypericum as a treatment for premenstrual syndrome.

Topics: Adolescent; Adult; Algorithms; Female; Humans; Hypericum; Middle Aged; Phytotherapy; Pilot Projects; Plants, Medicinal; Premenstrual Syndrome; Prospective Studies; Treatment Outcome